单侧完全性唇腭裂患者术前鼻牙槽骨整形的回顾性研究

目的：对接受术前鼻牙槽骨整形的单侧完全性唇腭裂患者进行回顾性研究,指导唇腭裂的术前非手术治疗。方法本研究回顾性分析了58例接受术前鼻牙槽骨整形的单侧唇腭裂患者,对正畸后未发生齿槽偏移和正畸后发生齿槽偏移的患者进行相关变量测量,并对测量结果进行统计学分析。结果本研究纳入的58例唇腭裂患者,有4例患者发生正畸后齿槽舌侧偏移,其余的54例患者正畸后未发生齿槽偏移。两组患者的前方齿槽裂隙宽度在矢状方向和垂直方向（PP’-Y、PP’-Z）存在显著差异,健侧齿槽前方与齿槽后方水平方向之间的夹角（∠PTT’）也存在统计学差异。结论单侧完全性唇腭裂患者在正畸前可能潜在齿槽偏移畸形,与前方齿槽在矢状和垂直方向裂隙畸形宽度,及健侧齿槽前方成角角度相关。无齿槽偏移患者可以直接使用矫治器缩窄裂隙宽度,而对于正畸后可能发生齿槽舌侧偏移的患者,需先矫正偏移畸形再缩小裂隙宽度。     

Effect of Post-Surgical Jaw-Orthopaedic Treatment in Unilateral Cleft Lip and Palate Patients

Reduction of the contraction of maxillary segments in newborn infants with unilateral cleft lip and palate by means of post-operative maxillary orthopaedic treatment was evaluated in 32 consecutive patients. Early surgery was performed in three stages and jaw-orthopaedic treatment with an acrylic plate was started one week after the first and again after the second operation. Between the first and second operation, between the second and third operation and during the period from the First operation to the age of three years there were no significant differences in changes of maxillary width dimensions between half of the children using the plates most frequently and the other half, with one exception. This difference was probably due to differences in initial values between the two groups of children. Thus, the influence on maxillary dimensions and dental occlusion of jaworthopaedic treatment, carried out according to our routines, was very limited. On the other hand, other treatment objectives might have been facilitated.     

A Longitudinal Study of The Nasal Symmetry in Unilateral Cleft Lip And Palate Patients Treated With Nasoalveolar Molding

Background  Nasoalveolar molding (NAM) has been extensively used as a presurgical technique in the treatment of unilateral cleft lip and palate (UCLP) over the last two decades. It has proven to be a useful tool to reduce the cleft size, improve nasal symmetry, and increase the columellar length. The long-term stability of these findings has not been conclusively proven. Methods  In this longitudinal study, the nasal symmetry of 24 NAM treated UCLP patients was evaluated to assess the 5-year stability of NAM. The basal photographs were shot postcheiloplasty (T1), at 1-year follow-up (T2), at 3-year follow-up (T3), and 5-year follow-up (T4) appointments. Results  In this study, we found that NAM was a useful adjuvant in achieving nasal symmetry in patients with UCLP in the immediate postoperative period. However, as the patients aged, there was a gradual loss of mean nasal height (by 22.83%) and columella length (by 24.89%), a mean gain in nasal width (by 40.25%) and alar base width (by 40.69%), and an increase in the columella deviation (by 3.46%) from the T1 to the T4 follow-up. Conclusion  Although there is no conclusive evidence, the loss of symmetry may be due to the unequal growth on the cleft and noncleft sides. These patients will be followed-up till end of growth for a definite conclusion on the long-term effect of NAM.     

Sizes of Dental Arches in Children with the Pierre Robin Syndrome and Isolated Cleft Palate Aged from 0.2 to Six Years

Abstract

Development of the dental arches and length and weight at birth were studied from 0.2 to 6 years of age in 78 children with Pierre Robin syndrome and 58 with isolated cleft palate. The growth of the maxillary dental arches was similar in both groups before palatal closure. The anterior width of the maxillary arch did not differ between the groups during the six year follow up period, but the depths of the maxillary and mandibular arches were significantly less (< 0.001) in the group with Pierre Robin syndrome compared with those with isolated cleft palates at the age of 3 and 6 years. The mandibular width at the first and second deciduous molars in the group with Pierre Robin syndrome was also significantly smaller (<0.01) than in the other group at the age of 6 years. The weight and length at birth were similar in both groups, and they were slightly lower than among the normal Finnish population.     

改良Langenbeck、Limberg手术及提肌吊带成形术联合治疗单侧完全性腭裂

目的探讨利用改良Langenbeck手术联合Limberg手术及提肌吊带成形术来治疗单侧完全性腭裂的临床治疗效果。方法本组共58例,均为单侧完全性腭裂,应用3种手术联合修复,包括改良Langenbeck手术、Limberg手术、提肌吊带成形术。术后随访3个月到4年,观察腭部创口愈合及腭咽闭合情况。结果随访50例患者中无1例发生腭瘘,术后腭咽闭合情况佳。结论3种手术联合修复治疗单侧完全性腭裂简单易行、远期效果佳,是一种临床上值得推广的方法。     

唇腭裂患儿序列治疗中的心理干预

目的探讨序列治疗中心理干预对唇腭裂患儿交往能力和行为问题的影响。方法将164 例唇腭裂患儿随机分为对照组与观察组各82例,观察组在“序”治疗的各阶段进行心理干预,对照组接受常规唇腭裂治疗、护理。结果观察组在心理测定的抑郁、交往不良及社会退缩方面改善显著优于对照组(均P<0.01)。结论心理干预在唇腭裂序列治疗中有着积极作用。     

Primary,Early Bone Grafting in Complete Clefts of the Lip and Palate: A Follow-up Study of 53 Cases

Fifty-three patients with complete unilateral and bilateral cleft lip and palate between the ages of 5 1/2 and 13 1/2 years have been followed up. Following preoperative jaw orthopedic treatment, when indicated, these cases were operated with lip closure and bone grafting with four mucoperiosteal flaps as described by Nordin (1960) and Bäckdahl & Nordin (1961). In the 14 bilateral cases this operation was done in two stages, one side at a time, in this series. At the follow-up, facial appearance, hearing, speech assessment, some facial angles and incidence of crossbites were examined. In the 39 unilateral cleft cases, 80% had an acceptable appearance while 20% needed secondary surgery of the lip and nose as rated independently by four doctors. In the 14 bilateral cases 50% needed secondary operation of the lip and nose. Speech assessment in the bone-grafted group was good or superior to that in a non-bone-grafted group of patients with clefts of the primary and the secondary palate. Open nasality and consonant articulations were also taken into consideration. No permanent hearing impairment was noted in these patients although they are prone to chronic ear diseases. No serious maldevelopment of the facial skeleton was noted in our study following primary, early bone grafting. The incidence of crossbite was comparatively low. This type of treatment is continuing at our centre since the results are promising. Comparison of similar studies from other centres with long-term follow-ups are called for.     

Psychosocial Adjustment in Norwegian Adults who Had Undergone Standardised Treatment of Complete Cleft Lip and Palate II. Self-reported problems and concerns with appearance

Aspects of social and psychological adjustment were investigated in a sample of 233 Norwegian adults 20–35 years old with repaired complete cleft lip and palate (CLP); in 126 the cleft was on the left, in 45 on the right, and in 62 it was bilateral. All subjects received a standardised regimen of care from the Oslo cleft palate team. The study, based on response to a questionnaire, partly copied a national survey of social and economic life in the Norwegian population. Adults with complete clefts were compared with a large control sample of the same age. The purpose of this paper is to describe the occurrence of common psychological problems among subjects with CLP. Anxiety, depression, and palpitations were reported about twice as often by subjects with CLP compared with controls, and these psychological problems were strongly associated with concerns about appearance, dentition, speech, and desire for further treatment. These findings suggest that there is an impaired level of psychological wellbeing among subgroups of subjects with clefts.     

快速成型三维模型在唇腭裂治疗中的应用研究

目的通过三维激光扫描、CAD、快速成型技术,建立唇腭裂患者齿槽区精确的数字三维模型,并快速成型制作三维实体模型。方法随机选取上海市第九人民医院10例唇腭裂患者,取齿槽区石膏模型,经三维激光扫描、CAD软件处理、快速成型等步骤,制作齿槽区三维实体模型。结果对传统石膏模型和数字三维实体模型的裂隙曲线进行测量比对,数字三维实体模型精确度达97.7%～99.01%,平均精确度为98.51%。结论通过快速成型技术建立唇腭裂齿槽区的精确化数字三维实体模型可替代石膏模型,对于病情判断、术前分析模拟以及未来新型唇腭裂术前矫形器的研发具有重要意义。     

Effect of the Periosteal Flap Technique on Cleft Width and the Formation of Alveolar Ridge in Relation to the Bite Level in Surgery for Cleft Lip and Palate

The effect of the periosteal flap technique on the width of the alveolar cleft and on the formation of the alveolar ridge in relation to the bite level was examined in 36 cases of complete unilateral cleft. Attention was paid to the time interval between periosteoplasty and palatal repair, and some of the cases were re-examined approx. a year after palatal repair. Patients with a well formed bridge between the alveolar segments displayed at least the same degree of narrowing of the cleft as those in which no formation of bone bridge was established roentgenologically. The occurrence of upward rotation at the end of the alveolar segments facing the cleft was similar in both groups. The original width of the cleft did not influence the upward rotation of the alveolar ridge, but it did influence the narrowing of the cleft.     

Reconstruction of Previously Failed Alveolar Bone Grafts with Medial Femoral Condyle Flap in Pediatric Cleft Lip and Palate Patients

Alveolar cleft reconstruction is important to increase the quality of life of cleft lip and palate patients. Usually, alveolar clefts can be reconstructed using bone grafts. However, bone grafting can be insufficient, and other alternatives may be necessary in wide and recalcitrant clefts. The medial femoral condyle (MFC) flap may be the solution for alveolar clefts that are impossible to reconstruct with bone grafting. In this study, the reconstruction of alveolar clefts in the pediatric cleft lip and palate population, using the MFC flap, is described.This study examined 9 pediatric patients whose alveolar clefts were reconstructed prospectively using MFC flap in 2015 and 2019. The age, gender, follow-up times, independent parameters, and existence of concomitant vestibulonasal fistulas of the patients were recorded. Computerized tomography images of the patients were evaluated to detect defect characteristics and evaluate the volume of flap postoperatively. Flap viability was confirmed with bone scintigraphy, and donor area morbidity was evaluated with the Dynamic Gait Index (DGI) in the postoperative period.The study included 7 male and 2 female patients. The mean age of the patients was 13. In addition to an alveolar cleft, 6 patients also had vestibulonasal fistula. It was observed that the volume of the flaps had not changed one year after the operation. The DGI score of all the patients was 24.Existing techniques may be inadequate in the reconstruction of wide and recalcitrant alveolar clefts. MFC flap may be the start of a new era for the treatment of alveolar clefts.     

Nasal Deformities and their Treatment in Secondary Repair of Cleft Lip Patients:A Clinical Study of 175 Cases

The author reports his own experience in 175 cases of secondary repair of cleft lip nose deformities. In spite of the great variability of these cases a relatively simple strategy has been defined, based on a precise study of the lesions. In unilateral cases the nose is deviated entirely to the normal side, not only because of nasal bone deviation but also and mainly because of septal deviation. The nasal tip is distorted because of the alar cartilage displacement which results from bone deviation. Rhinoplasty is usually performed by a submucosal approach through a vertical incision in the columella. It includes septal straightening, nasal osteotomies, and sharp dissection and reduction of the triangular cartilages and alar cartilages to allow of their suturing in the normal position. In bilateral cleft lip cases the main deformity of the nose is shortness of the columella. Here, two techniques have been utilized. In those rare cases where the lip was correct in height and width, a V—Y plasty on the nasal tip was performed with good results. In most cases the Abbe-Estlander flap was the procedure of choice. These rhinoplasties were carried out on patients between 15 and 20 years of age, and were always considered to be the last stage of secondary cleft lip repair, particularly after the maxillary bone defects had been corrected.     

Unrepaired Clefts in the Hard Palate: Speech Deficits At the Ages of 5 and 7 Years and Their Relationship to Size of the Cleft

The purpose of the study was to investigate the relationship between the size of oronasal openings in the hard palate and speech deficits. Audiotape recordings and plaster casts were taken according to standard procedures at 5 and 7 years of age from 22 consecutive children born with complete unilateral cleft lip and palate treated at Sahlgrenska University Hospital, Göteborg, Sweden. The soft palate had been repaired before the age of 12 months, whereas the cleft in the hard palate was left unrepaired, to be closed later. Perceptual judgements of nine speech variables at 5 and 7 years of age were correlated with measures of the area of the residual cleft in the hard palate. "Retracted oral articulation" (to velar place) found in nine of the 22 children correlated significantly with the area of the cleft at the age of 5 years but not later. The establishment of this particular speech error seems to be related to the size of an oronasal opening.